Summary

Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related death worldwide. Unlike most solid cancers, future incidence and mortality rates for HCC were projected to largely increase in several regions around the world over the next decade. Given the complexity of the disease and the common association of HCC and cirrhosis, careful multidisciplinary assessment of tumor stage, liver function, and physical status is required for proper staging and therapeutic planning. Patients with early-stage HCC should be considered for any of the available curative therapies, including liver transplantation, surgical resection, and image-guided ablation.

Transcatheter arterial chemoembolization is recommended as the standard of care for the treatment of large or multinodular non-invasive tumors in patients who have neither evidence of hepatic decompensation nor extrahepatic spread of the disease, i.e., those cases classified as intermediate stage according to the Barcelona Clinic for Liver Cancer (BCLC) staging system. Radioembolization with yttrium-90 (Y90) microspheres is increasingly used to treat patients at more advanced tumor stages, including those with portal vein invasion. The multitargeted tyrosine kinase inhibitor sorafenib is the only systemic treatment currently available for HCC patients unsuitable for surgical or interventional therapies. Despite the recent advances and refinements in therapeutic strategies, tumor recurrence remains a challenge in patients with HCC. Several clinical trials investigating different combinations of locoregional and systemic treatments for preventing early recurrence and improving long-term outcomes are ongoing.

Introduction

HCC is the third leading cause of cancer-related death worldwide. Unlike most solid cancers, future incidence and mortality rates for HCC were projected to largely increase in several regions around the world over the next decade, mostly as a result of the dissemination of hepatitis B and C virus infection. Patients with cirrhosis are at the highest risk of developing HCC and should be monitored every 6 months with imaging techniques to diagnose the tumor at an early, asymptomatic stage. Lesions detected by imaging surveillance require proper diagnostic approach. Confirmation of tiny nodules as true HCC may be challenging, as pathologic changes inherent in cirrhosis – such as regenerative or dysplastic nodules – mimic a small tumor. Treatment choice is also difficult, given the complexity of the disease and the large number of potentially useful therapies, and requires careful multidisciplinary assessment of tumor stage, liver function, and physical status.